HIPAA Form - Ameriben Designation of Authorized Representitive

Most insurance carrier's require your written authorization in order for a third party, (HealthJoy, LLC), to obtain any information regarding all covered individuals on your policy.  You will need to complete a separate authorization form for each covered individual that you wish to allow HealthJoy, LLC permission to obtain information and speak on your behalf.  

For your convenience we have provided a link to your insurance carrier's web-portal: CLICK HERE, where you can login to your account, if you have not registered your account you will need to register before you are able to login.  Once you have logged in you should be able to locate your insurance carrier's authorization form, or you can click the link also provided below, to download the blank copy of your insurance carrier's authorization form to complete.